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Home My WebLink About1000-136.-1-21 of so 'OWN OF SOUTHOL Rental Permit be 1389 Owner: 275 Oak LLC Occupied as: Single Family Dwelling Located at: 2835 Harbor Ln Cutchogue 136.-1-21 Maximum Permitted Occupancy: 2 Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection. Issued: 10/28/2025 Expiration: 10/28/2027 ode rce ent Official This Notice must be posted by the main entrance t a 'mes TOWN OF SOUTHOLD—BU LDINO DEPARTMENT Nov, Town Hall Annex 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631)765-9502 httns://www.southoldtQw°nnv. o RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every e� ) Section A. +B,ol dloq t 4A Property Information: "I " 01, Rental Property Address: 2635 Harbor Lane Cutcho ue NY. Tax Map Number: 1000 SECTION 136 -BLOCK 100 -LOT 021,000 -02,2.000 SECTION B. OWNER INFORMATION: Property Owner Name: 275 Oak LLC Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 115 Sutton St. Brooklyn, NY. 11222 115 Sutton St. Brooklyn, NY. 11222 Telephone Number(s): Daytime 917-327-6032 Evening Emergency Property Owner Email Address: office@sfainteriors.com Page 1 of 4 Section C. Authorized Agent Information: to Name of Authorized Agent of dwelling unit, if any: Lugo 1 V�J Address of Authorized Agent (no P.O. Boxes): OOD \X/15cl lotO Z161 NYa I Oo�-o Mailing Address of Authorized Agent: 11 Telephone Number (s): Daytimeo[1 5 0&ening Emergency Email Address: Q OH L• �!� Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: Address of Managing Agent (no P.O. Boxes): Mailing Address of Managing Agent: Telephone Number (s): Daytime Evening Emergency Email Address: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier (for example, Unit 1, Unit 2, Unit 3 or Apt A, B, Q the use of each room in the Rental Dwelling Unit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: K l """ 160 Ste COOKI N G 1-MIJ Ro0M - 2.1(o S� F - E l R�= ?� - �33 S F g i of �G Root to - too -G F LrL� '66ACM SQIF SL a `P 13RT h NG 069 tilNG - 5-0 SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety inspection by Code Enforcement Official is required. If the owner chooses not to have said inspection performed by the Town, a certification from a licensed architect, a licensed professional engineer or a home inspector who has a valid New York State Uniform Fire Prevention Building Code Certification is required stating that the property which is the subject of the rental permit application is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. 0 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold XI am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3 of 4 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) I ) , certify under penalty of perjury,the following: 1. 1 am the owner of the property identified in "Section A" of this application. 2. The property owner's legal address set forth in "Section B" of this application is my legal address and I understand the Town will use the address for service pursuant to all applicable laws and rules. I further acknowledge that I will notify the Town of Southold Building Department of any changes of address within five (5) days of any changes thereto. 3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and agreed to abide by the same. 4. 1 will notify the Town within five (5) business days s to any change to the information regarding Authorized Agent,-Managing Agent, or Site Manager, Property Owner's Name: �� 1)�� d Property Owner's Signature: Sworn to before tfyts°, day of 2021) ---------------- __ Official" Public Signature and Original Notary Stamp FQ.alified 7o. 1 SZYNSKw te of New York 155857nk C „r„, ix„- m, Expire o e . Page 4 of 4 'W. � QF t1� W TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 /3(O- /-� / Him" S P Em C;' -T 10 [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [�- RENTAL REMARKS: eeO C441h 4, c aAA hasp JJO5� P DATE 3,-�25� INSPECTOR ur ,`+ , .<" qlq�� C,�A� �-e� TOWN OF SOUTHOLD BUILDII DEIST. 631-765-1802 1& 0 Oft Moak Im VID tv E T 10 [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL 4v/ c MATE INSPECTOR ._ June 14, 2025 Town Hall Annex ro Telephone(631)765-1802 54375 Main Road n � Fax(631)765-950 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION ''`,` Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Pro essiorlal:seal reauired Lor Architect or Engineer, licensed Home Inspector rrlust rov°ide co v of valid current certi icatiorl Rental Property SCTM Number: Rental Property Address: 2835 Harbor Ln. Cutch® ue NY 11935 Owner/Name: 25 Oak LLC Rental Dwelling Unit Identifier: Number &Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sq., Bedroom #2-90 sq., etc.) Bedroom #1 100 s ft Bedroom #2 100 sqft Property Description (Include all improvements indicated on survey) __Sjvng� family home I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold, the Residential Code of New York State,the Building Code of New York State, the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. Victor Cornelius III CEO Inspector Print Name and Title ceo# 1216-0283 o final Signat re Please place professional seal: A T en � y o4K s 1 TOWN OF SOUTHOLD PROPERTY RECORD 7 0�.� «1 `� - � OWNER STREET VILLAGE ]:DISTRICT SUB. LOV��,,,`- -,.FORMER OWNER N ACREAGE D Za W TYPE OF BUILDING RES. SEAS. VL. FARM comm. I IND. I CB. MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS 0 7= ON cacl(a 21- 4BB L:e 61 (Rooi r —77\r4 �I 4%2 vo L :L ask AGE BUILDING CONDITION e L I NEW NORMAL BELOW ABOVE I FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD -7 Tillable 1 BULKHEAD Tillable 2 DOCK Tillable 3 Woodland Swampland Brushland House Plot Total i M. Bldg. Foundation Bath Extension E Basement Floors Extension Ext. Walls Interior Finish Extension Fire Place Heat Porch Roof Type Porch Rooms 1 st Floor Breezeway ', Patio Rooms 2nd Floor Garage Driveway Dormer O. B. J FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. . .??697„ . . . . . . . . Date , . . .September ,27 . . . . . . . . . . . w ., 1979. THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • • • • . . Location of Property 2835 Harbor La,/250. Oak Street. cuteho�ue House No. Street Hamlet County Tax Map No. 1000 Section .1 36. . , . . . . .Block . . .Q . . . . . . . . . .Lot . .021 & 022 , , , Subdivision . .. gene Heights Filed Map No. 856. Lot No. 93 ,thru ,99. Requirements for a one family dwe:l.ling built prior to conforms substantially to the April*23 ' W , 19 "7pursuant to whichte o 1 Occupyncy. . . 6 7 . . . . . . . . . . dated . .September.27 . x . . . . . . . 19 79 ,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . One. Family Dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. The certificate is issued to . . , .Robert J,M Deroski , , , . . , , , . . . , w+n(oer, . of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . • . • . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . N . . . . .. . . . . . . . . . . . . . . . . . . Building Inspector Rev 4/79 r w FORM NO.4 TOWN OF SOUTHOL.D BUILDING DEPARTMENT Town Clerk's Office Southold,N.Y. p of occupairicy No, ., �?!.. . . . », . Date Septe�al er 27,. :!979. . .. .... 19 .. . THIS CERTIFIES that the building .. . . . . .. ..... .. . ..... ... . .. . .. .... . ..... .... ... ... .. Location of Property 2835. Harbor.Lane j250 Oak Street t ?p e . .. ., . .. . .. .. ... . . . # .. .0r NQouwir Na . . . . . . St�isrc . County Tax sp No. 1006 Section . . . 136. . . ..Block ..Of... ... ..Lot Subdivision., eR4.HP19M . . . . . . . ,.. .Fged Map No, ..85A :.Lot No,93.tbr0U9b.9.8 conforms nb#AUtWIY to the Application for Building Permit heretofore flied in this office dated . . . .. . .July, 5 ... . ., 1974.pursuant to which Building Permit No. .. . Z.'4 . ...... .... dated .. J 4Y. 25. .. . . . . . . . . . . •• 19 7.4,was issued,and conforms to all of the requirements of the applicable provisions of the law.The occupancy for which this certificate is issued is ......... ..... . . . . . .. . . . . . .. . ... . .... .. .. .. . ... . . . ....... .. .. The certificate is issued to . . . . . .. . . 9$e . . .:: ,.. ..„.... . . . .... .. .. . of the aforesaid building. Suffolk County Department of Health Approval . . . . . ». .. . , . .....NIR.. ...,. . . .... . , .. ... . UNDERWRITERS CERTIFICATE NO . .... . . . .. . . .. ... . . ..... ......... .. .......... . EAPector Rev UN